1986-628 BUILDING PERMIT
TOWN OF QUEENSBURY No. 86-628
WARREN COUNTY, NEW YORK
ER ISSION is hereby granted to Robert and Teresa Ous tecky
OWNER of property located at McCormack Drive Street, Road or Ave.
in the Town of Queensbury,To Construct or place a Deck added between dwelling and pnnl
at the above location in accordance to application together with plot plans and other information hereto filed and `*
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
1. OWNER'S Address is RR #1 1-3
Lake George, New York
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2. CONTRACTOR or BUI LDER'S Namero
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Gary Mumblo
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3. CONTRACTOR or BUILDER'S Address
P. 0. Box 164
Hudson Falls, New York 12839
4. ARCHITECT'S Name co
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5. ARCHITECT'S Address
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6. TYPE of Construction—(Please indicate by X)
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( )Wood Frame ( ) Masonry ( )Steel (
7. PLANS and Specifications
No. deck per plot plan, specifications and application submitted. a
8. Proposed Use
One—Family Dwelling — deck added
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10.00
$ PERMIT FEE PAID—THIS PERMIT EXPIRES April 1 19 87,
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Queensbury before the expiration date.) OQ
Dated at the Town of Queensbury this 24th Day of September 19 86
SIGNED BY a`,6 -) for the Town of Queensbury
Building and Zoning Inspector
TO BE COMPLETED BY BLDG. DEPT.
Application No. • f ..1
awn O QueenituryPermit Issued 19 l t rs r r r , = 1
BUILDING and ZONING DEPARTMENT Permit Expires 19 Ofill ( :, i•: aBay and Haviland Road, R.D. 1 Box 98 Zoning Designation S Y. `�' id
Clueensbury, New York 12801 variance No. _ ) '
Site Plan Review No.
3 v Approved by: 1j °�tiT �p2����
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APPLICATION FOR ( } • a R 134
BUILDING AND ZONING PERMIT I
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ;:*
A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION. ANSWER ALL OF THE FOLLOWING.
The undersigned hereby applies for a Building Permit to do the following work which will •
be done in accordance with the description, plans and specifications submitted, and such
special conditions as may be indicated on the Permit.
A.
• The owner of this property is: /e0,6/i/e/ /9/1/2) j/g2e4 Q6)67/g-7-67
P.O. Address /2/ / D,Y/i-lo 2 -e-,E6:0,2�1�,ry y /2 4S Tel. 79.3--0 7/-0
Property Location: ' ' i/ -- - 1)2,, Tax Map No._ / /
Street number or building lot number
Subdivision name (if applicable) C,..00)27`A1VS/Z /zT✓512-45 (;-/EC, 20 •
THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS BUILDING CODES IS: .
Name P.O. Address �} Tel No.
Name of builder �,1, m(J i GD Address A® /60X i(vg/Li���� Tel. 7V 7`19,a/
Name of plumber Address Tel.
Name of mason Address Tel.
NATURE OF PROPOSED WORK: * ZONING INFORMATION:
Construction of a new building * A PLOT PLAN MUST BE PREPARED AND SUBMITTED,
Addition to a building * drawn reasonably to scale and attached hereto,
Alteration to a building * showing_clearly and distinctly al:l:-bu lding: , '
(no change t':l exterior cr dimensions) * whether existing or proposed and indicate all
Other work (describe) TVc.,, -* set-back dimensions tram property lines. .Givc:
* street and number or lot number and indicate
FOR DEMOLITION PERMIT, STATE SIZE AND * whether interior or corner lot. Show location
LOCATION OF STRUCTURES AFFECTED. of water supply and location and configuration
* of septic disposal area.
*
* COMPLETE INFORMATION REQUIRED BELOW.
* Size of property ft X ft.
R� * Existing building(s) Size �c1 ft X S y. ft.
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PROPOSED BUILDING AND USE: ° t
�� * Existing building(s) Use ,Q1i7S/D/(4/
Size of new structure ft X ft *
Foundation-pier/slab/crawl/partial/full * Proposed building, distance from property line
(circle one) *
* Front yard ft Rear yard ft
No. of stories (habitable space) * Side yards ft and ft
Height (grade to ridge) ft. * If on corner, setback from side street ft
If residential, no. of families
No. of rooms(excluding baths) * OCCUPANCY INFORMATION
No. of bedrooms *
* PRIMARY BUILDING -
No. of bathrooms
Primary heating system One family dwellingT
Type of fuel / * Two family dwelling
No. of fireplaces to be installed * Multiple dwelling / Number of units
Will a wood stove be installed? * Permanent occupancy
Central Air conditioning? * Transient occupancy
* Business
BUILDING STYLE, PRIMARY STRUCTURE * Industrial
Ranch Contemporary Log cabin * Other
Raised ranch Mansion Duplex * If addition, what will use be.
Split level Old style Bungalow *
Cape Cod Cottage Other * ACCESSORY BUILDING-
Colonial Row Town House * Detached garage/one car/ two car/ car
( CIRCLE ONE PLEASE ) * • _Attached garage/one car/ two car/ l w O car
* * * * * * * * * * * * * * * * * * Private storage building
ESTIMATED MARKET VALUE OF * Other ' '
CONSTRUCTION 1 / soo *
INFORMATION ON BUILDING SPECIFICATIONS, ON RE'IERSE SIDE OF THIS SHEET, TO BE COMPLETED!
Form BPA 4/86 and-vl
BUILDING PERMIT APPLICATION CONTINUED -
BUILDING SPECIFICATIONS:
Type of construction, wood frame, fire safe,etc. / .53r/2/: i,e z .h uJcc
Will any second-hand or ungraded lumber be used? If so, for what? Ai•)
•
Foundation wall material Thickness
Depth of foundation below grade (to bottom of footing)
Will there be a cellar? Heated or unheated? Floor sq. footage sq ft
Will there be a basement? Will any portion be used as living space?
(If so, what portion? sq.ft. - - Type of use?
Type of roof ,- sloped/flat/shed/other Material of roof
Size, wood studs Co "X " spacing $ e "ce;. length ft.
Joists(floor beams) 1st. floor "X " spacing "o.c. span ft.
Joists (floor beams) 2nd. floor "X / U " spacing /(,,"o.c. span V ft.
Overlays(ceiling beams) "X " spacing "o.c. span ft.
Roof rafters "X " spacing o.c. span ft.
Roof trusses(pre-engineered) spacing "o.c. span ft.
Exterior wall finish Of what material?
Interior wall finish
If a garage is to be attached, describe materials to be used for FIRE SEPARATION:
Is there to be an opening between garage and dwelling? If so will a Fire-rated
door, enclosure, and self-closing device be provided?
Will a flue-lined chimney be installed? Height above roof ft.
Depth of chimney foundation below grade ft.
Depth of fireplace hearth ft. in.
Water supply - Municipal or private well
SEPTIC SYSTEM Distance from ANY private well(including adjoining properties ft.
(A separate application is necessary for any repair or new installation of septic system)
Town of Queensbury AFFIDAVIT STATE OF NEW YORK
County of Warren
I swear that to the best of my knowledge and belief the statements contained
in this application, together with the plans and specifications submitted, are a true and
complete, statement of all proposed work to be done on the described premises and that all
provisions of the BUILDING CODE, THE ZONING ORDINANCE, and all other laws pertaining to
the proposed work shall be complied with, vzhether.. specified or not, and that such work is
authorized by the owner.
SWORN TO BEFORE ME THIS Signature
Owner, owner's ,
ent arch t,contractor
g
day of ' 19
Notary Public, Warren County, N.Y.
* * * * * * * * * * * * * * * * * * *- * * * * * * * * * * * * * * * * * * * * * * * * * * *
SPECIAL CONDITIONS OF THE PERMIT:
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